WORLD ACADEMY OF CERAMICS - INTERNATIONAL CERAMICS PRIZE 2012

NOMINATION FORM

TO BE FILLED, DOWNLOADED AND RETURNED TO
WORLD ACADEMY OF CERAMICS PO BOX 174 48018 FAENZA ITALY
NOT LATER THAN MARCH 15, 2011

(Please return this Form together with letters of at least two supporters for nomination)

Please refer to the Nomination Procedures before filling this form.

1. Nominator

Name

Institutional affiliation and title:

Office full mailing address:

Fax: Phone: E-mail
Home address (optional):

Fax: Phone: E-mail

2. Candidate

Name

Institutional affiliation and title:

Office full mailing address:

3. Supporters of Nomination (letters attached. At least two supporters are required)
	Name Name Name Name

4. Achievement for which the candidate is nominated:

5. Brief description of the achievement:

6. Additional documentation (optional):
	Brief Curriculum Vitae of Candidate Selected List of Publications Reprints of representative Papers (up to 3 papers related to the basis for nomination) Others (please specify)